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Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
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A Novel Virtual Reality-Based System for Measuring Deviation Angle in Strabismus: A Prospective Study.

Jhih-Yi Lu1, Yin-Cheng Liu2, Jui-Bang Lu2

  • 1Eye Center, China Medical University Hospital, Taichung 404327, Taiwan.

Diagnostics (Basel, Switzerland)
|September 27, 2025
PubMed
Summary
This summary is machine-generated.

A new virtual reality (VR) system software effectively measures ocular deviation in strabismus patients. The camera rotation (CR) method within the VR system shows strong correlation with traditional tests, offering a reliable diagnostic tool.

Keywords:
camera rotatestrabismustarget offsetvirtual reality

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Area of Science:

  • Ophthalmology
  • Medical Technology
  • Virtual Reality Applications

Background:

  • Strabismus diagnosis requires accurate ocular deviation measurement.
  • Existing methods may have limitations in certain patient populations.
  • Virtual Reality (VR) presents a novel platform for ophthalmic diagnostics.

Purpose of the Study:

  • To develop and validate a new VR system software for measuring ocular deviation.
  • To compare VR-based methods (target offset and camera rotation) with the alternate prism cover test (APCT).
  • To assess the reliability of the VR system for exotropia (XT) and esotropia (ET) patients.

Main Methods:

  • Prospective study including patients with exotropia (XT) and esotropia (ET).
  • Ocular deviation measured using the alternate prism cover test (APCT), VR target offset (TO), and VR camera rotation (CR).
  • Comparative analysis of measurement results between APCT and VR methods.

Main Results:

  • The VR system, particularly the CR method, demonstrated comparable results to APCT (p=0.604).
  • Both VR methods underestimated deviation in XT patients compared to APCT (p=0.008 for TO, p=0.001 for CR).
  • The CR method showed a stronger correlation with APCT (R²=0.934) than the TO method (R²=0.874).

Conclusions:

  • The newly developed VR system software with the CR method is a reliable tool for measuring ocular deviation.
  • This VR system provides a foundation for advanced immersive diagnostic and therapeutic applications in ophthalmology.
  • The CR method's ability to shift the visual scene enhances its potential for accurate strabismus assessment.